(Summary of Changes included in printable PDF below)
CareBridge EVV Integration Guide and Technical Specifications
INTRODUCTION TO CAREBRIDGE INTEGRATION
OVERVIEW
Welcome! This Integration Guide is intended to help providers and EVV Vendors throughout the process of integrating with CareBridge to provide EVV data for the purposes of data aggregation. If at any point you have questions, our team here is here to help: evvintegration@carebridgehealth.com. A PDF of this guide is available here.
WHAT IS CAREBRIDGE?
CareBridge is a company formed to support care for people who receive Long-Term Services and Supports (LTSS). We offer LTSS solutions including an Electronic Visit Verification Platform that can be utilized via a mobile phone, GPS-enabled tablet, landline and web-based portal to record service delivery and facilitate day-to-day management of members’ appointments. CareBridge also supports a wide array of EVV data aggregation solutions in which CareBridge builds an integration with a provider’s EVV system, allowing provider agencies to keep their current EVV solution while still providing required data back to the health plan or state.
INTEGRATION OVERVIEW
CareBridge will engage providers that choose to integrate CareBridge's Platform with a 21st Century Cures Act compliant EVV solution. CareBridge's Platform supports data aggregation by way of accepting EVV Visit Data from third-party vendors and subsequently generating claims to be submitted to the clearinghouse and MCOs.
All EVV Visit and Claims data must ultimately be reflected in the CareBridge Platform for MCO receipt, payment, and monitoring.
The following is a description of the steps in the data aggregation process:
1. Appointments / Visits data file is placed in SFTP folder by provider and/or third-party vendor
2. CareBridge imports and processes Appointments / Visits file
3. CareBridge places response file in SFTP for review by provider and/or third-party vendor
a. Provider takes action on response errors and resubmits
4. CareBridge utilizes visits data to generate claims and submits to clearinghouse / MCOs
5. Providers can continue to receive claim remittances through previously established
mechanisms (Availity)
Appointments / Visits data should be submitted to CareBridge at least once daily for all appointments / visits that have had incremental changes since last submission.
SFTP CONFIGURATION REQUIREMENTS
• CareBridge test environment: sftp.dev.carebridgehealth.com
• CareBridge production environment: sftp.prd.carebridgehealth.com
• Port: 22
• Login Credentials: Vendor's public SSH key
• When transferring files via SFTP, select BINARY mode
SFTP FOLDER STRUCTURE
/input – Used to send files to CareBridge for import into the CareBridge system
/output – Used to retrieve Response Files from CareBridge
SFTP RETENTION POLICY
• Once files have been downloaded from /output, they should be deleted. If they are not
deleted, they will be retained for 30 days.
• Files will be deleted from /input upon load and processing by CareBridge
FILE FORMAT SPECIFICATIONS
• File type: CSV (pipe-delimited),
• Values can be enclosed with double quotes (and should be when a pipe could exist in the data)
• Headers should be included
• One row per appointment / visit
• All DateTime fields should be UTC with zero offset
• Visit data will be rejected if there is already an existing ApptID that has been claimed but has
not yet reached a terminal status (Rejected, Paid, Denied)
NAMING CONVENTION
Visit Files from Third Party EVV Vendors
The general naming convention is as follows:
VISITS_NJ_ProviderTaxID_YYYYMMDDHHMMSS.CSV
For Test Files, “TEST” will prepend the file name as follows:
TEST_VISITS_NJ_ProviderTaxID_YYYYMMDDHHMMSS.CSV
Note: The state initials are required for files to be processed.
CareBridge Response File
VISITS_NJ_ProviderTaxID_ERROR_YYYYMMDDHHMMSS.txt
For Test Files, “TEST” will prepend the file name as follows:
TEST_VISITS_NJ_ProviderTaxID_ERROR_YYYYMMDDHHMMSS.txt
TESTING INSTRUCTIONS
Testing Overview
Vendors are required to complete testing scenarios in order to begin sending production data to CareBridge. If a vendor has already completed the integration process in New Jersey and is sending production data for PCS Procedure Codes, additional testing is not required for Home Health.
The goal of the testing process is to ensure that data is able to be successfully transmitted from Third-party vendors to CareBridge. CareBridge has created several test cases designed to ensure specific scenarios are understood and passed by vendors prior to production go-live.
The test cases are outlined in a separate document: New Jersey - Third-Party EVV Vendor Integration Testing Process Guide, available on the CareBridge EVV Data Integration web page: http://evvintegration.carebridgehealth.com, under Additional Documents for Third-Party Vendors > New Jersey - Third-Party EVV Vendor Integration Testing Process Guide.
Additionally, there are 3 different testing milestones summarized below:
- Connection Testing – Vendors credentials are working properly and they are able to successful connect to the SFTP site.
- File Validation Testing – Vendors are able to successfully send files in accordance with our file specifications.
- Data Validation Testing– Vendors are able to send records in accordance with our data specifications. A full list of CareBridge Pre-Billing Validations can be found under Technical Specifications for Third-Party Vendors > Pre-Billing Validation Errors.
File Validation Testing (Milestone 2)
Once a vendor has successfully completed the required test cases and is approved to send data to production, they can begin sending production appointment/visit data to the production environment.
CareBridge highly recommends that EVV Vendors follow the process outlined below:
- Send a file in the production environment with actual visit/appointment data.
a. Only send 1-5 rows of data initially.
b. Send visit data with the ClaimAction field as null.
c. At least one row of data should be visit data rather than appointment data. - Download the response file in the /output folder and review the pre-billing errors.
- Update data to remedy those errors; email evvintegration@carebridgehealth.com with questions about specific errors.
- Repeat steps 1-3 until you receive a response file with headers only. This means that there were no row level errors and the data was processed successfully.
- Repeat steps 1-4 for each unique provider agency TIN for whom you provide EVV services.
Claim Submitted Via CareBridge
Once a vendor is able to successfully send a file of appointment/visit data without errors on behalf of a provider, they can coordinate with the provider to submit their first claim. Note: for Horizon members, claims will not be submitted via CareBridge. ClaimAction “E” should be used for Horizon visits.
- Re-send the visit data previously sent in Initial Production Data Go-Live with the ClaimAction field as 'N'. This will generate a claim for those visits.
Note: If visits sent in Data Validation Testing – Production included the ClaimAction field as 'N' rather than null, both Data Validation in Production and Claim Submitted via CareBridge would be completed simultaneously.
Integration "Go-Live"
Once a vendor is able to successfully submit a claim via CareBridge, they can begin implementation of Integration Go-Live – submitting all claims via CareBridge.
This will require coordination between the vendor, the agency(ies) they support and CareBridge.
The process is as follows:
- Direct providers using your system to the CareBridge Integration Document for Providers site. It contains instructions for their expectations and next steps.
- Identify a go-live date with each agency to begin sending all data and communicate that date to CareBridge.
- Develop a process with your agency for resolving response file errors on an ongoing basis.
- It is up to vendors and their agencies whether response files will be passed to their agencies directly or incorporated into the Third-party EVV system’s UI.
- It is required that vendors leverage both the:
-
-
- The Pre-Billing Validation Report in addition to response files to ensure providers have the most up-to-date information regarding outstanding visit errors.
- The Appointment Status Report to ensure providers have accurate information regarding visit or claim status over time.
-
- The supplemental report specifications can be found on the CareBridge EVV Data Integration web page: http://evvintegration.carebridgehealth.com, under Additional Documents for Third-Party Vendors.
-
-
-
- Integrating agencies will not be able to make updates to their data in the CareBridge EVV portal. Updated data should be sent via integration process.
DATA FIELD SPECIFICATIONS
CareBridge Response File Format
Field | Value | Description |
ERROR_CODE | See sections below | The error code indicating the type of issue |
ERROR_DESCRIPTION | See sections below | The description of the error code, this is dynamic based on the error |
IS_FILE_ERROR | True or False | Indicates if the error is a file level error or row / field level error |
ERROR_SEVERITY | ERROR or WARNING | Indicates the severity of the error |
FILE_NAME | Name of the inbound file | Name of the file that was received by CareBridge |
In addition to these 5 fields, the CareBridge response file will also contain each field included in the inbound data file for Third-Party EVV Vendor reference.
File Level Validation
Error Number | Description |
F1001 | File is not an expected file type. |
F1002 | File contains invalid delimiters. |
F1003 | File cannot be parsed, it may be incomplete or invalid. |
F1004 | File is a duplicate. |
F1005 | File exceeds max allowed file size. (5 GB) |
Appointments / Visits Data File Format
Field No | Field Name | Description | Data Type | Required for Scheduled Appointment |
Required for Completed Visit |
Example | Max Length |
1 |
VendorName |
Name of EVV vendor sending data |
Alphanumeric |
Y |
Y |
EVV Vendor |
|
2 |
TransactionID |
Unique identifier for the transaction and should be unique in every file. It is only used for tracking and troubleshooting purposes |
Alphanumeric |
Y |
Y |
71256731 |
|
3 |
TransactionDateTime |
Time stamp associated with the visit data being sent to CareBridge |
Datetime |
Y |
Y |
YYYY-MM-DD HH:MM |
|
4 |
ProviderID |
Unique identifier for the provider |
Alphanumeric |
Y |
Y |
43134 |
100 |
5 |
ProviderName |
Name of provider |
Alphanumeric |
Y |
Y |
Home Health, LLC |
255 |
6 |
ProviderNPI |
NPI of provider |
Numeric |
Y |
Y |
1609927608 |
10 |
7 |
ProviderEIN |
Tax ID or EIN of provider |
Alphanumeric |
Y |
Y |
208076837
|
9 |
8 |
ProviderMedicaidID |
MedicaidID number for Provider |
Alphanumeric |
Y |
Y |
982123567 |
|
9 |
ApptID |
Unique identifier for the visit, used to identify an appointment and should be consistent for every appointment update |
Alphanumeric |
Y |
Y |
1231248391 |
100 |
10 |
CaregiverFName |
First name of caregiver who completed the visit |
Alphanumeric |
Y |
Y |
John |
|
11 |
CaregiverLName |
Last name of caregiver who completed the visit |
Alphanumeric |
Y |
Y |
Smith |
|
12 |
CaregiverID |
Unique ID Assigned to caregiver (Employee ID) |
Alphanumeric |
Y |
Y |
982123 |
|
13 |
CaregiverLicenseNumber |
License number for caregiver (Format: 2 integers, 2 letters, then 8 integers) (Format requirements are not enforced for Home Health Service Codes) |
Alphanumeric |
Y |
Y |
22AA88888888 |
12 |
14 |
CaregiverDateOfBirth |
Date of birth of caregiver |
Alphanumeric |
Y |
Y |
YYYY-MM-DD |
|
15 |
MemberFName |
First name of member |
Alphanumeric |
Y |
Y |
Jane |
|
16 |
MemberLName |
Last name of member |
Alphanumeric |
Y |
Y |
Johnson |
|
17 |
MemberMedicaidID |
Medicaid ID for member - 12 digits |
Numeric |
Y |
Y |
36271424521 |
12 |
18 |
MemberID |
Subscriber ID |
Alphanumeric |
N |
N |
47138493 |
|
19 |
MemberDateOfBirth |
Date of birth of member |
Alphanumeric |
N |
N |
YYYY-MM-DD |
|
20 |
ApptStartDateTime |
Date / Time that the appointment was scheduled to begin |
DateTime |
Y |
Y |
YYYY-MM-DD HH:MM |
|
21 |
ApptEndDateTime |
Date / Time that the appointment was scheduled to end |
DateTime |
Y |
Y |
YYYY-MM-DD HH:MM |
|
22 |
ApptCancelled |
(C) if appointment was cancelled |
Alphanumeric |
N |
N |
C |
|
23 |
CheckInDateTime |
Date / Time that the visit was checked into |
Datetime |
N |
Y |
YYYY-MM-DD HH:MM |
|
24 |
CheckInMethod |
EVV (E), Manual (M), IVR (I) |
Alphanumeric |
N |
Y |
E |
|
25 |
CheckInStreetAddress |
Street address where check in occurred |
Alphanumeric |
N |
Y |
926 Main St |
|
26 |
CheckInStreetAddress2 |
Additional street address info where check in occurred |
Alphanumeric |
N |
N |
Suite B |
|
27 |
CheckInCity |
City where check in occurred |
Alphanumeric |
N |
Y |
Nashville |
|
28 |
CheckInState |
State where check in occurred |
Alphanumeric |
N |
Y |
TN |
|
29 |
CheckInZip |
Zip code where check in occurred |
Alphanumeric |
N |
Y |
37206 |
|
30 |
CheckInLat |
Latitude of coordinates where check in occurred |
Alphanumeric |
N |
Y |
##.###### |
|
31 |
CheckInLong |
Longitude of coordinates where check in occurred |
Alphanumeric |
N |
Y |
###.###### |
|
32 |
CheckOutDateTime |
Date / Time that the visit was checked out of |
Datetime |
N |
Y |
YYYY-MM-DD HH:MM |
|
33 |
CheckOutMethod |
EVV (E), Manual (M), IVR (I) |
Alphanumeric |
N |
Y |
E |
|
34 |
CheckOutStreetAddress |
Address where check out occurred |
Alphanumeric
|
N |
Y |
926 Main St |
|
35 |
CheckOutStreetAddress2 |
Additional address info where check out occurred |
Alphanumeric |
N |
N |
Suite B |
|
36 |
CheckOutCity |
City where check out occurred |
Alphanumeric |
N |
Y |
Nashville |
|
37 |
CheckOutState |
State where check out occurred |
Alphanumeric |
N |
Y |
TN |
|
38 |
CheckOutZip |
Zip code where check out occurred |
Alphanumeric |
N |
Y |
37206 |
|
39 |
CheckOutLat |
Latitude of coordinates where check out occurred |
Alphanumeric |
N |
Y |
##.###### |
|
40 |
CheckOutLong |
Longitude of coordinates where check out occurred |
Alphanumeric
|
N |
Y |
###.###### |
|
41 |
AuthRefNumber |
Authorization Number as indicated by health plan |
Alphanumeric |
Y |
Y unless not required for Service Code (see Home Health Service Codes section below) |
1080421390 |
|
42 |
ServiceCode |
Service code for services rendered during visit (HCPCS Procedure Code) |
Alphanumeric |
Y |
Y |
S5125 |
|
43 |
Modifier 1 |
Modifier code for services rendered during visit |
Alphanumeric |
N |
N |
U5 |
|
44 |
Modifier 2 |
Second modifier code for services rendered during visit |
Alphanumeric |
N |
N |
UA |
|
45 |
Modifier 3 |
Third modifier code for services rendered during visit |
Alphanumeric |
N |
N |
96 |
|
46 |
Modifier 4 |
Fourth modifier code for services rendered during visit |
Alphanumeric |
N |
N |
59 |
|
47 |
TimeZone |
Time zone that the visit took place in |
Alphanumeric |
Y |
Y |
US/Eastern |
|
48 |
CheckInIVRPhoneNumber |
Phone Number used to check in |
Alphanumeric |
N |
Y |
+14156665555 |
|
49 |
CheckOutIVRPhoneNumber |
Phone Number used to check out |
Alphanumeric |
N |
Y |
+14156665555 |
|
50 |
ApptNote |
Free text note related to the visit |
Alphanumeric |
N |
N |
Scheduling related note |
|
51 |
DiagnosisCode |
ICD-10 Diagnosis code attributed to the visit |
Alphanumeric |
N |
Y |
I50.9
|
|
52 |
ApptAttestation |
Member attestation associated with the visit |
Alphanumeric |
N |
Y |
See Member Attestation Codes table below |
|
53 |
Rate |
Billed unit rate associated with the visit |
Decimal |
Y |
Y |
3.85 |
|
54 |
ManualReason |
Reason for manual entry associated with the visit |
Alphanumeric |
N |
Y |
See Manual Reasons Codes table below |
|
55 |
LateReason |
Reason the visit was late |
Alphanumeric |
N |
Y |
See Late Reasons Codes table below |
|
56 |
LateAction |
Action taken due to visit being late |
Alphanumeric |
N |
Y |
See Late Actions Codes table below |
|
57 |
MissedReason |
Reason the visit was missed |
Alphanumeric |
N |
Y |
See Missed Reasons Codes table below |
|
58 |
MissedAction |
Action taken due to the visit being missed |
Alphanumeric |
N |
Y |
See Missed Actions Codes table below |
|
59 |
CarePlanTasksCompleted |
Tilda delimited list of tasks completed during the visit |
Alphanumeric |
N |
N |
Toileting~Bathing |
|
60 |
CarePlanTasksNotCompleted |
Tilda delimited list of tasks not completed during the visit |
Alphanumeric |
N |
N |
Laundry~ Trash Removal |
|
61 |
CaregiverSurveyQuestions |
Tilda delimited list of survey questions presented to the caregiver |
Alphanumeric |
N |
N |
Has the member fallen since the last visit?~Is the member looking or acting different than they usually do? |
|
62 |
CaregiverSurveyResponses |
Tilda delimited list of survey responses to questions presented to the caregiver in the same order as the questions listed in CaregiverSurveyQuestions field |
Alphanumeric |
N |
N |
Yes~No |
|
63 |
ClaimAction |
New Claim (N), Corrected Claim (C), Void (V), Claims Billed Externally-Not Via CareBridge (E) |
Alphanumeric |
N |
Y |
N |
|
64 |
MCOID |
Identifies health plan the member is associated with |
Alphanumeric |
Y |
Y |
See MCOID table below |
|
65 |
CaregiverSSN |
Social Security Number of the Caregiver - HHAX application requirement; this is not required by the State of NJ for 1/1/2021 go-live. If you do not wish to send this, please default to sending all nines, ex. ‘999999999’ |
Alphanumeric |
N |
Y |
999999999 |
9 |
66 |
CaregiverGender |
Male (M), Female (F), or Other (O). This is an HHAX application requirement. If you do not wish to send this, please default to Other (O) |
Alphanumeric |
Y |
Y |
M |
|
67 |
CaregiverType |
Caregiver’s Type. This is an HHAX application requirement. |
Alphanumeric |
Y |
Y |
non_skilled |
|
68 |
CaregiverHireDate |
Date on which caregiver hired by Provider. This is an HHAX application requirement |
Alphanumeric |
Y |
Y |
YYYY-MM-DD |
|
69 |
RevenueCode |
Revenue Code that should be used for billing. (See table below for additional details) |
Alphanumeric |
N |
Y for Home Health Visits if ClaimType is 837I |
See Home Health Service and Revenue Code Definitions below |
|
70 |
AttendingProviderFirstName | First Name of Attending Provider that should be included on Claim | Alphanumeric | Y for Home Health Visits | Y for Home Health Visits if ClaimType is 837I | John |
|
71 |
AttendingProviderLastName | Last Name of Attending Provider that should be included on Claim | Alphanumeric | Y for Home Health Visits | Y for Home Health Visits if ClaimType is 837I | Smith |
|
72 |
AttendingProviderNPI | NPI of Attending Provider that should be included on Claim | Alphanumeric | Y for Home Health Visits | Y for Home Health Visits if ClaimType is 837I | 1234567893 |
|
73 |
ClaimType |
Which 837 claim type should be generated (Institutional / Professional) |
Alphanumeric |
N |
Y if provider is configured to bill on 837I or 837P |
837I / 837P |
|
101 |
Claim Invoice Number 1 |
Claim level invoice number in third-party system |
These fields can be used for reconciliation of the data sent to CareBridge. To enable these fields, additional testing is required. |
||||
102 |
Claim Invoice Number 2 |
Claim level invoice number in third-party system |
|||||
103 |
Line Item Invoice Number 1 |
Unique identifier of the invoice line item in the third-party |
|||||
104 |
Line Item Invoice Number 2 |
Unique identifier of the invoice line item in the third-party system |
PCS Service Codes and Unit Definitions
Service Code | Modifier 1 | Modifier 2 | Unit Type | Unit Quantity | Payers |
S5125 | SE | HQ | Minutes | 15 | NJ_AGP, NJ_HZ |
S5125 | SE | U3 | Minutes | 15 | NJ_AGP, NJ_HZ |
S5130 | HQ | Minutes | 15 | NJ_AGP, NJ_HZ | |
S5130 |
Minutes | 15 | NJ_AGP, NJ_HZ | ||
T1005 | Minutes | 15 | NJ_AGP, NJ_HZ | ||
T1019 | HQ | Minutes | 15 | NJ_AGP, NJ_HZ | |
T1019 | SE | U1 | Minutes | 15 | NJ_AGP, NJ_HZ |
T1019 | SE | Minutes | 15 | NJ_AGP, NJ_HZ | |
T1019 | TN | Minutes | 15 | NJ_AGP | |
T1019 | Minutes | 15 | NJ_AGP, NJ_HZ | ||
T1020 | Visit | 1 | NJ_AGP, NJ_HZ |
Home Health Service Codes and Unit Definitions*
Service Code | Modifier 13 | Modifier 2 | Unit Type | Unit Quantity |
Horizon AuthRefNumber Expected4 |
97597 |
|
|
Visit |
1 |
N |
996011 |
|
|
Visit |
1 |
Y |
996021 |
|
|
Each additional hour |
1 |
Y |
G0299 |
|
|
Minutes |
15 |
N |
S9122 |
|
|
Hours |
1 |
Y |
S9123 |
|
|
Hours |
1 |
N |
S9124 |
|
|
Hours |
1 |
N |
S9127 |
|
|
Per Diem2 |
1 |
Y |
T1000 |
|
|
Minutes |
15 |
Y |
T1000 |
UA |
|
Minutes |
15 |
Y |
T1002 |
|
|
Minutes |
15 |
Y |
T1002 |
UA |
|
Minutes |
15 |
Y |
T1003 |
|
|
Minutes |
15 |
Y |
T1003 |
UA |
|
Minutes |
15 |
Y |
T1030 |
|
|
Per Diem2 |
1 |
Y |
T1031 |
|
|
Per Diem2 |
1 |
Y |
92507 |
|
|
Per Diem2 |
1 |
Y |
92507 |
96 |
|
Per Diem2 |
1 |
Y |
92507 |
96 |
59 |
Per Diem2 |
1 |
Y |
97110 |
|
|
Minutes |
15 |
Y |
97110 |
96 |
|
Minutes |
15 |
Y |
97110 |
96 |
59 |
Minutes |
15 |
Y |
971291 |
|
|
Minutes |
15 |
Y |
971291 |
96 |
|
Minutes |
15 |
Y |
971301 |
|
|
Minutes |
15 |
Y |
971301 |
96 |
|
Minutes |
15 |
Y |
971301 |
96 |
59 |
Minutes |
15 |
Y |
97535 |
|
|
Minutes |
15 |
Y |
97535 |
96 |
|
Minutes |
15 |
Y |
97535 |
96 |
59 |
Minutes |
15 |
Y |
G0151 |
|
|
Minutes |
15 |
N |
G0152 |
|
|
Minutes |
15 |
N |
S9128 |
|
|
Visit |
1 |
Y |
S9129 |
|
|
Visit |
1 |
Y |
S9131 |
|
|
Visit |
1 |
Y |
G0300 |
|
|
Minutes |
15 |
N |
G0153 |
Minutes |
15 |
N | ||
G0155 |
Minutes |
15 |
N |
1 Please see section for Primary and Add-On Service Codes
2 Per Diem Units are always billed as a single unit with a maximum of 1 unit per day.
3 For Horizon and Wellpoint, there are no validations on Modifiers, up to 4 modifiers are allowed for Wellpoint. Up to 2 modifiers will be passed to Horizon. For Horizon, providers should ensure that Modifiers match what has been claimed to Horizon. For Wellpoint, even if no modifiers are listed in the table above, all modifiers are allowable to be included on visit data.
4 AuthRefNumbers are required for all Procedure Codes for Wellpoint New Jersey. From a system perspective, all Horizon Home Health Service Codes are treated as "Sometimes" authorized.
Home Health Service Codes and Revenue Codes*
Service Code | Revenue Code |
Revenue Code Description |
97507
|
0440 |
General - Speech Therapy (ST) |
0441 |
Visit Charge - ST |
|
0442 |
Hourly Charge - ST |
|
0443 |
Group Rate - ST |
|
0444 |
Evaluation or Reevaluation - ST |
|
0449 |
Other - ST |
|
97110 |
0420 |
General - Physical Therapy (PT) |
0421 |
Visit Charge - PT |
|
0422 |
Hourly Charge - PT |
|
0423 |
Group Rate - PT |
|
0424 |
Evaluation or Reevaluation - PT |
|
0429 |
Other - PT |
|
97129 |
0430 |
General - Occupational Therapy (OT) |
0431 |
Visit Charge - OT |
|
0432 |
Hourly Charge - OT |
|
0433 |
Group Rate - OT |
|
0434 |
Evaluation or Reevaluation - OT |
|
0439 |
Other - OT |
|
0440 |
General - ST |
|
0441 |
Visit Charge - ST |
|
0442 |
Hourly Charge - ST |
|
0443 |
Group Rate - ST |
|
0444 |
Evaluation or Reevaluation - ST |
|
0449 |
Other - ST |
|
97130 |
0430 |
General - OT |
0431 |
Visit Charge - OT |
|
0432 |
Hourly Charge - OT |
|
0433 |
Group Rate - OT |
|
0434 |
Evaluation or Reevaluation - OT |
|
0439 |
Other - OT |
|
0440 |
General - ST |
|
0441 |
Visit Charge - ST |
|
0442 |
Hourly Charge - ST |
|
0443 |
Group Rate - ST |
|
0444 |
Evaluation or Reevaluation - ST |
|
0449 |
Other - ST |
|
97535 |
0430 |
General - OT |
0431 |
Visit Charge - OT |
|
0432 |
Hourly Charge - OT |
|
0433 |
Group Rate - OT |
|
0434 |
Evaluation or Reevaluation - OT |
|
0439 |
Other - OT |
|
99601 |
0550 |
General - Skilled Nursing (SN) |
0551 |
Visit Charge - SN |
|
0552 |
Hourly Charge - SN |
|
0559 |
Other - SN |
|
0989 |
Private-duty Nurse - SN |
|
99602 |
0550 |
General - SN |
0551 |
Visit Charge - SN |
|
0552 |
Hourly Charge - SN |
|
0559 |
Other - SN |
|
0989 |
Private-duty Nurse - SN |
|
G0151 |
0420 |
General - PT |
0421 |
Visit Charge - PT |
|
0422 |
Hourly Charge - PT |
|
0423 |
Group Rate - PT |
|
0424 |
Evaluation or Reevaluation - PT |
|
0429 |
Other - PT |
|
G0152 |
0430 |
General - OT |
0431 |
Visit Charge - OT |
|
0432 |
Hourly Charge - OT |
|
0433 |
Group Rate - OT |
|
0434 |
Evaluation or Reevaluation - OT |
|
0439 |
Other - OT |
|
G0153 |
0440 |
General - ST |
0441 |
Visit Charge - ST |
|
0442 |
Hourly Charge - ST |
|
0443 |
Group Rate - ST |
|
0444 |
Evaluation or Reevaluation - ST |
|
0449 |
Other - ST |
|
G0155 |
0560 |
General - Home Health Medical Social Services - (HM) |
0561 |
Visit Charge - HM |
|
0562 |
Hourly Charge -HM |
|
0569 |
Other - HM |
|
G0299 |
0550 |
General - SN |
0551 |
Visit Charge - SN |
|
0552 |
Hourly Charge - SN |
|
0559 |
Other - SN |
|
0989 |
Private-duty Nurse - SN |
|
G0300 |
0550 |
General - SN |
0551 |
Visit Charge - SN |
|
0552 |
Hourly Charge - SN |
|
0559 |
Other - SN |
|
0989 |
Private-duty Nurse - SN |
|
S9122 |
0570 |
General - Home Health Aide (HA) |
0571 |
Visit Charge - HA |
|
0572 |
Hourly Charge - HA |
|
0579 |
Other - HA |
|
0989 |
Private-duty Nurse - HA |
|
S9123 |
0550 |
General - SN |
0551 |
Visit Charge - SN |
|
0552 |
Hourly Charge - SN |
|
0559 |
Other - SN |
|
0989 |
Private-duty Nurse - SN |
|
S9124 |
0550 |
General - SN |
0551 |
Visit Charge - SN |
|
0552 |
Hourly Charge - SN |
|
0559 |
Other - SN |
|
0989 |
Private-duty Nurse - SN |
|
S9127 |
0560 |
General - HM |
0561 |
Visit Charge - HM |
|
0562 |
Hourly Charge - HM |
|
0569 |
Other - HM |
|
S9128 |
0440 |
General - ST |
0441 |
Visit Charge - ST |
|
0442 |
Hourly Charge - ST |
|
0443 |
Group Rate - ST |
|
0444 |
Evaluation or Reevaluation - ST |
|
0449 |
Other - ST |
|
S9129 |
0430 |
General - OT |
0431 |
Visit Charge - OT |
|
0432 |
Hourly Charge - OT |
|
0433 |
Group Rate - OT |
|
0434 |
Evaluation or Reevaluation - OT |
|
0439 |
Other - OT |
|
S9131 |
0420 |
General - PT |
0421 |
Visit Charge - PT |
|
0422 |
Hourly Charge - PT |
|
0423 |
Group Rate - PT |
|
0424 |
Evaluation or Reevaluation - PT |
|
0429 |
Other - PT |
|
T1000 |
0550 |
General - SN |
0551 |
Visit Charge - SN |
|
0552 |
Hourly Charge - SN |
|
0559 |
Other - SN |
|
0989 |
Private-duty Nurse - SN |
|
T1002 (UA) |
0550 |
General - SN |
0551 |
Visit Charge - SN |
|
0552 |
Hourly Charge - SN |
|
0559 |
Other - SN |
|
0989 |
Private-duty Nurse - SN |
|
T1003 (UA) |
0550 |
General - SN |
0551 |
Visit Charge - SN |
|
0552 |
Hourly Charge - SN |
|
0559 |
Other - SN |
|
0989 |
Private-duty Nurse - SN |
|
T1030 |
0550 |
General - SN |
0551 |
Visit Charge - SN |
|
0552 |
Hourly Charge - SN |
|
0559 |
Other - SN |
|
0989 |
Private-duty Nurse - SN |
|
T1031 |
0550 |
General - SN |
0551 |
Visit Charge - SN |
|
0552 |
Hourly Charge - SN |
|
0559 |
Other - SN |
|
0989 |
Private-duty Nurse - SN |
* Revenue Codes should only be used for Wellpoint New Jersey services.
Member Attestation Codes
Code | Description |
MA1000 | Complete |
MA1005 | Member Refused |
MA1010 | Member Unable |
MA1015 | No Signature (Other) |
Manual Reasons Codes
Code | Description |
MR2200 |
Phone number did not link to the Member |
MR2201 |
Member won't let attendant use phone |
MR2202 |
Member doesn't have a phone in home |
MR2203 |
Phone in use by Member or individual in Member's home |
MR2204 |
Member received services outside of the home |
MR2205 |
Member's phone line not working (technical issue or natural disaster) |
MR2206 |
Member requested to change/cancel scheduled visit; or the scheduled visit has been cancelled due to the Member’s services being suspended |
MR2207 |
Address did not link to the Member (GPS) |
MR2208 |
Attendant failed to call in |
MR2209 |
Attendant failed to call out |
MR2210 |
Attendant failed to call in and out |
MR2211 |
Attendant called in to or out of the EVV system early or late |
MR2212 |
Attendant's identification number(s) does not match the scheduled shift or task discrepancy/task does not match plan of care |
MR2213 |
Attendant entered invalid fixed location device code(s) |
MR2214 |
Attendant failed to report to Member’s home |
MR2215 |
Fixed location device on order or pending placement in the home |
MR2216 |
Fixed location device malfunctioned |
MR2217 |
Attendant unable to use mobile device |
MR2218 |
Attendant unable to connect to internet or EVV system down |
MR2219 |
Data Entry Error |
MR2220 |
Agency unable to provide replacement coverage (no show, no replacement) |
MR2221 |
Timesheet Received |
MR2222 |
Other |
MR2223 |
EPSDT PDN During the School Day |
Late Reasons Codes
Code | Description |
LR1000 | Caregiver forgot to check in |
LR1005 | Technical issue |
LR1010 | Member would not allow staff to use device |
LR1015 | Member rescheduled |
Late Reason Actions Taken Codes
Code | Description |
LA1000 | Rescheduled |
LA1005 | Back-up plan initiated |
LA1010 | Contacted service coordinator |
LA1015 | Contacted MCO member services |
LA1020 | Caregiver checked in late |
Missed Reasons Codes
Code | Description |
MVR2600 |
Agency unable to provide replacement coverage (no show, no replacement) |
MVR2601 |
Attendant failed to report to Member’s home |
MVR2602 |
Member requested to change/cancel scheduled visit; or the scheduled visit has been cancelled due to the Member’s services being suspended |
MVR2603 |
Member Refused Service |
MVR2604 |
Member Refused Service - original aide on vacation |
MVR2605 |
COVID-19: All other cases where the agency could not staff due to COVID-19 |
MVR2606 |
COVID-19: Member refused, receiving service through informal supports |
MVR2607 |
COVID-19: Member refused, self-isolating, not receiving service |
MVR2608 |
Hospitalization unplanned |
MVR2609 |
Other |
Missed Visit Actions Taken Codes
Code | Description |
MVA1051 |
Confirmed with the Member or the Member’s family member/representative and documented |
MVA1052 |
New attendant assigned to Member |
MVA1053 |
Other |
MVA1054 |
Service(s) cancelled or suspended until further notice |
MVA1055 |
Unverified visit |
MVA1056 |
Visit rescheduled |
MCOID Codes*
Code | Description |
NJ_AGP | Wellpoint New Jersey |
NJ_HZ | Horizon New Jersey Health |
Primary and Add On Service Codes
- Primary/Add On Service Codes (99601/99602 and 97129/97130) are service codes that have explicit divisions required for billing purposes. These services do not need to be divided from an EVV perspective. For example, if three hours of infusion services are provided, then first two hours are billed under 99601 and the last hour should be billed under 99602.
Wellpoint New Jersey
- The examples and rules below utilize 99601/99602, but identical logic applies for 97129/97130 (with the relevant unit type being per 15 mins rather than hourly).
- Providers must have both primary and add-on service codes authorized in order for billing to function correctly in all cases. If only one of the primary or add-on service code is authorized, the provider should reach out to Wellpoint New Jersey.
- From an EVV data perspective, it would be acceptable to send the entire visit using 99601. If the visit is longer than two hours, when the claim is generated, CareBridge will automatically apply the following rules:
Example 1 - Single Visit, More than 2 Hours
Rule: Claims for 99601/99602 for each billing provider/member/authorization, will be billed as separate claim lines on the same claim.
ApptID | Checkout Date | Checkout Time | Checkout Date | Checkout Time | Procedure Code in Visit File | Claim # | Claim DOS | Claim Line Procedure Code | Units | Claim Line # | |
1000 | 8/1/2022 | 9:00 AM | 8/1/2022 | 1:00 PM | 99601 | 100 | 8/1/2022 | 99601 | 1 | 100 | |
99602 | 2 | 200 |
Example 2 - Single Visit, Less than 2 hours
Rule: If only one visit is received for a calendar day (for each billing provider/member/authorization), the first two hours will be billed under 99601 and any additional hours will be billed as 99602.
ApptID | Checkout Date | Checkout Time | Checkout Date | Checkout Time | Procedure Code in Visit File | Claim # | Claim DOS | Claim Line Procedure Code | Units | Claim Line # | |
1001 | 8/2/2022 | 9:00 AM | 8/2/2022 | 10:00 AM | 99601 | 102 | 8/2/2022 | 99601 | 1 | 101 |
Example 3 - Multiple Visits, Initial Visit Less than 2 hours
Rule: If multiple visits are received for a calendar day, and the first visit is less than two hours, then that visit will be billed under 99601 and the additional visits will be billed under 99602 with units rounding up for each hour.
ApptID | Checkout Date | Checkout Time | Checkout Date | Checkout Time | Procedure Code in Visit File | Claim # | Claim DOS | Claim Line Procedure Code | Units | Claim Line # | |
1002 | 8/3/2022 | 9:00 AM | 8/3/2022 | 10:00 AM | 99601 | 103 | 8/3/2022 | 99601 | 1 | 102 | |
1003 | 8/3/2022 | 1:00 PM | 8/3/2022 | 2:00 PM | 99601 | 99602 | 1 | 201 |
Example 4 - Multiple Visits, Initial Visit more than 2 Hours
Rule: If multiple visits are received for a calendar day, and the first visit is longer than two hours, then the first two hours of that visit will be billed under 99601 and the remaining duration of that visit will be combined with any additional visits and the total additional duration will be billed under 99602 with units rounding up for each hour.
ApptID | Checkout Date | Checkout Time | Checkout Date | Checkout Time | Procedure Code in Visit File | Claim # | Claim DOS | Claim Line Procedure Code | Units | Claim Line # | |
1004 | 8/4/2022 | 9:00 AM | 8/4/2022 | 1:30 PM | 99601 | 104 | 8/4/2022 | 99601 | 1 | 103 | |
1005 | 8/4/2022 | 2:30 PM | 8/4/2022 | 3:30 PM | 99601 | 99602 | 4 | 202 |
Example 5 - Single Visit, Overnight
Rule: If a visit spans midnight, then the logic above will be applied, but all of the units will be billed on the initial date of service. This ensures that 99602 is not billed separately from 99601.
ApptID | Checkout Date | Checkout Time | Checkout Date | Checkout Time | Procedure Code in Visit File | Claim # | Claim DOS | Claim Line Procedure Code | Units | Claim Line # | |
1006 | 8/5/2022 | 9:00 PM | 8/6/2022 | 1:00 AM | 99601 | 105 | 8/5/2022 | 99601 | 1 | 100 | |
99602 | 2 | 200 |
Horizon
- Visits for Primary and Add-On service codes for Horizon members should be sent to CareBridge in accordance with the way that they are claimed to Horizon.
Pre-Billing Validations
Pre-billing checks are performed in the CareBridge system to ensure that clean claims are generated and that EVV Data is valid. If validation errors are present in response files or appointment error files, they must be resolved by the agency or vendor prior to claim generation.
A full list of CareBridge Pre-Billing Validations can be found under Technical Specifications for Third-Party Vendors > Pre-Billing Validations
Comments
The following fields have been added:
- RevenueCode
- AttendingProviderFirstName
- AttendingProviderLastName
- AttendingProviderNPI
- ClaimType
The Revenue Code Table for Wellpoint New Jersey Home Health services has been added. Targeted effective date 11/15/24.
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